Independence Blue Cross and Sun Life Collaborate on Stop Loss Insurance

Independence Blue Cross (IBC) is the leading health insurance organization in southeastern Pennsylvania. With its affiliates, IBC serves more than 8 million people nationwide.

IBC’s portfolio includes coverage for national businesses, large employer groups, and small businesses; portable benefits for when clients travel or live abroad; Medicare supplemental and Medicare Advantage products; Medicaid; and specialty services such as vision and dental coverage. Affiliates provide specialty services and products, including third-party benefits administration and worker’s compensation insurance.

In addition, IBC subsidiaries provide specialty services and products including third-party benefits administration, pharmacy benefits management services, and workers’ compensation insurance.

IBC and Sun Life U.S. announced a new collaboration to exclusively provide Stop Loss insurance for Independence’s self-funded group customers. Stop Loss insurance can protect self-funded employers who take on the financial risk of providing health insurance for their employees against large, unpredictable, or catastrophic losses from higher-than-anticipated claims. The Independence and Sun Life collaboration and all features will be effective January 1, 2024.

The Independence collaboration with Sun Life for Stop Loss insurance will have:

customizable solutions with competitive pricing and reduced fees for IBC groups:

• reporting with actionable insights to make it easier for employers to make decisions about their Independence self-funded plans.
• cash flow solutions with an advance funding program to pay claims at the time they are received, rather than waiting for a reimbursement check after they are paid.
• other new program features to be introduced in the future as IBC establishes Sun Life as the company’s exclusive Stop Loss partner.

Gene therapies are eligible for coverage under the Independence Blue Cross medical benefit, and each gene therapy has its own medical policy. IBC reviews these policies regularly to ensure that coverage criteria are comprehensive and current. All gene therapies require precertification approval to confirm that members meet these coverage criteria before receiving treatment.

IBC recently established an Advanced Network for Gene-Based Therapeutics, which identifies best-in-class facilities for members to receive gene-based therapies. Both the Children’s Hospital of Philadelphia (CHOP) and Penn Medicine are at the forefront of gene therapy research and development.

These hospitals have reputations for exceeding quality, safety, and value benchmarks. In addition, they train their staff in recommended protocols established by the manufacturer to get the best possible results. IBC works closely with these hospitals to ensure that they provide complete, coordinated care that centers around the patient.

IBC is also pursuing outcomes-based agreements with certain manufacturers. Under these arrangements, the manufacturer would provide a warranty on cost if the therapy does not produce expected outcomes in members who receive treatment.

Takeaway: IBC is also pursuing outcomes-based agreements with certain manufacturers. Under these arrangements, the manufacturer would provide a warranty on cost if the therapy does not produce expected outcomes in members who receive treatment

Comprehensive intelligence is available in AMI’s Cell & Gene Therapy Financing Solutions 2023 Review